Udwadia T E, Udwadia R T, Menon K, Kaul P, Kukreja L, Jain R, Prasad S
Department of Surgery, J. J. Hospital, Bombay, Indian.
Int Surg. 1995 Oct-Dec;80(4):371-5.
We present experience of laparoscopic surgery commencing in 1972 with diagnostic laparoscopy in a Surgical Unit in Bombay. By 1990 we had completed 2800 diagnostic laparoscopies with no mortality, 0.08% complication rate, 85% positive diagnosis and an instrument cost of about Rs. 35 (US $ 1.2) per patient. We have over the past 5 years performed 890 laparoscopic cholecystectomies (LC) with no mortality, no blood transfusion, and one CBD injury. With reusable equipment, monopolar diathermy and selective cholangiography, LC is cost-efficient in a developing country. Over this period over 60 laparoscopic appendectomies were performed, with the use of catgut ligatures and self-made endo-loops. laparoscopic appendectomy is cost-effective under our conditions. We have done 46 hernia repairs, and by contrast find it far more expensive and with inferior results to standard hernia repair. Advanced laparoscopy for ulcer and reflux disease, bowel resection, retroperitoneal and thoracic laparoscopy are being given a trial in several centres in the developing world.
我们介绍了自1972年起在孟买一家外科单位开展腹腔镜手术（始于诊断性腹腔镜检查）的经验。到1990年，我们已完成2800例诊断性腹腔镜检查，无死亡病例，并发症发生率为0.08%，诊断阳性率为85%，每位患者的器械成本约为35卢比（1.2美元）。在过去5年里，我们进行了890例腹腔镜胆囊切除术（LC），无死亡病例，无输血情况，有1例胆总管损伤。使用可重复使用的设备、单极电凝和选择性胆管造影，LC在发展中国家具有成本效益。在此期间，我们进行了60多例腹腔镜阑尾切除术，使用了肠线结扎和自制的内镜圈套器。在我们的条件下，腹腔镜阑尾切除术具有成本效益。我们做了46例疝修补术，相比之下，发现其成本远高于标准疝修补术，且效果较差。发展中世界的几个中心正在对用于溃疡和反流疾病、肠切除、腹膜后和胸腔腹腔镜检查的先进腹腔镜技术进行试验。
